There was a time not so long ago that the rate of gonorrhea was at a historic low and syphilis was close to elimination, both in the United States and in Yellowstone County.

Those days are over, and it’s got the medical community concerned even more now that gonorrhea is growing more resistant to treatment.

“It’s really shot up in terms of syphilis and gonorrhea cases in Montana, as well as chlamydia,” said Dr. Chris Baumert, a family physician at RiverStone Health in Billings. “The problem with gonorrhea is it is one of CDC’s infections that’s being very closely watched because there is only one set of medications to treat it.”

In fact, the U.S. Centers for Disease Control and Prevention has labeled the threat of antibiotic-resistant gonorrhea “one of the nation’s most urgent public health threats.”

The Sexually Transmitted Disease Surveillance 2017 report ranked gonorrhea as the second most common notifiable condition in the United States, with 555,608 cases reported in the United States. Chlamydia ranks first, and syphilis is third.

The rate of gonorrhea cases in the U.S. has increased 75.2 percent, the CDC reported, since the historic low in 2009. Rates of reported gonorrhea, syphilis and chlamydia in Yellowstone County all have seen large increases since 2001.

STDs can be difficult for infected men and women to identify. Symptoms may be nonexistent or confusing.

Nationally, half of STDs occur among young people ages 15 to 24. In Yellowstone County, it skews older, to people ages 20 to 45, though there are infected partners on either side of that age range.

All three STDs can be passed from person to person through vaginal, oral and anal sex. Teens who think they’re safe if they stick to oral sex are fooling themselves, Baumert said.

“And all of these infections can put you at higher risk for acquiring HIV,” he said. “That’s concerning because there is HIV in this community and we are having new cases every year.”

In women, diseases such as gonorrhea and chlamydia can cause pelvic inflammatory disease and long-term health consequences such as infertility.

“And then all three can be passed from mom to baby,” he said. “So pregnant women need to be tested.”

A CDC report released in September said the number of mothers in the U.S. who passed syphilis to their babies more than doubled since 2013, from 362 in 2013 to 918 in 2017. That was “the highest number of recorded cases in 20 years,” the report said.

In previous years, in Montana, syphilis occurred primarily among men who had sex with men, according to the DPHHS. In the early part of 2018, four of the nine reported cases involved women, and two-thirds of them were from Yellowstone County.

In Yellowstone County, another risk to both men and women is increased drug use. Needle sharing can boost the number of cases of HIV, which, for example, can be transmitted to male or female partners who have sex with an HIV-infected drug user.

“Some communities around the nation have implemented nonprofit needle sharing programs so at the very least they are preventing those people already using drugs from getting infections too,” Baumert said. “We don’t have any sort of program like that in Billings."

Testing for STDs is relatively easy, Baumert said. The test for syphilis requires a blood test. Gonorrhea and Chlamydia require a swab test of the potentially affected area, vaginal, penile, rectum and throat.

Baumert acknowledges that can be an uncomfortable conversation for patients and physicians.

“It’s important for providers to be frank,” he said.

Treatment is also straightforward. For syphilis in its early stages, a shot of penicillin is all that is needed.

“For gonorrhea and chlamydia, usually a simple treatment can be administered at the clinic,” Baumert said. “It takes an injection of antibiotic and a pill they can take at the same time.”

Of course the person diagnosed isn’t the only one who needs to be treated. When an STD diagnosis is made, both the lab and the provider are obligated to report the finding to the county health department, which in Billings is RiverStone Health.

Kim Bailey, Public Health Service Communicable Disease Manager at RiverStone, is one of three employees who are involved in partner notification. After verifying the original partner’s diagnosis and treatment, they contact that person to find out the names of their recent sexual partners.

Sometimes the person hangs up. Other times they’re hard to track down.

“We do everything we can to find people, and sometimes we’re like detectives, using all our resources we have on the information we’re given.”

Bailey assures the people she calls that their confidentiality will be protected when she follows up with their partners.

“We just notify the person named as a contact to whatever disease it is, and tell them we’d like them to get tested and treated,” she said.

In these days of social media and online dating apps, technology is providing new venues for anonymous sex. People pick an app, create a user name and search for someone wanting to hook up, and then delete that user name and pick another one.

That can make it difficult to track down partners, Bailey said. But she has found ways to use social media to figure out who the partners might be, and if she finds them, she recommends they take action.

“We see the whole gamut of people being angry to being thankful and grateful,” she said.

It’s all in the name of helping people get treated so they don’t suffer the long-term consequences of having untreated STDs.

The other thing, Bailey said, is for people to be aware of what they need to do to prevent getting a sexually transmitted disease.

“The safest thing is not to have sex,” she said. “If you aren’t sexually active, you won’t get an STD.”

The second choice is for two people to be in a monogamous relationship, with neither one having outside sex. Beyond that, condoms can be effective in preventing transmission of an STD.

"If you don't know if your partner is having other partners and you're going to be sexually active, you have to do something to protect yourself," Bailey said.

STD numbers grow in county, state

The numbers tell the story, when it comes to sexually transmitted diseases.

In Yellowstone County, from a low of eight cases in 2001, the number of gonorrhea cases grew to 234 in 2016, dropped to 199 in 2017, but totaled 301 for the first nine months of 2018.

Also in Yellowstone County, 33 cases of syphilis (primary and secondary) were reported in 2017, compared to zero cases in 2001 and 9 in 2016. This year, that number is already up to 26 through the end of September.

Chlamydia cases, which totaled 264 in 2001, rose to 741 in 2015, 658 in 2016, 754 in 2017 and are already at 672 as of Sept. 30.

The state of Montana has seen similar increases for STDs, according to the state’s Department of Public Health and Human Services:

For gonorrhea, 782 cases of gonorrhea in 2017, or 573 cases up through Oct. 6, 2017, verses 887 cases to date in 2018.

For syphilis (primary and secondary), 48 cases in 2017, or 38 cases up through Oct. 6, 2017, verses 37 cases to date in 2018.

For chlamydia, 4,564 in 2017, or 3,371 up through Oct. 6, 2017, verses 3,855 to date in 2018.

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